Learning Objectives

In this chapter we will define and discuss complementary and alternative medicine and briefly consider its use from a historical perspective. We will then identify those dimensions of holistic well-being that are most relevant to wellness tourism, as we well as delve into the socio-historical context in which associated activities have been undertaken in the United States.

At the conclusion of this chapter students will be able to:

• Define and discuss complementary and alternative medicine (CAM) within an historical context, including:
  • The impact of the Flexner Report on CAM
  • and the differences between nature-based remedies, holistic health and integrative medicine
•  Identify dimensions of holistic well-being
• Describe the historical evolution of the dimensions of well-being in the context of social movements such as the New Age, and paying particular attention to the:
  • Spiritual
  • Psychological
  • and Physical dimensions of well-being.

Complementary and Alternative Medicine

The terms complementary and alternative medicine (CAM) were coined in relation to conventional Western medicine. Holistic approaches to health and well-being are as old as recorded history. The oldest known medical system originates from India, dating back over 5,000 years (Shivanagutti et al., 2022b). This system, called Ayurveda (a Sanskrit term which translates to the study or science of life), was documented in ancient texts that describe health as a dynamic interplay between the body, mind, and spirit, including internal energy systems (the doshas: Vata, Pitta, and Kapha) and external factors such as nature and cosmic forces (Shivanagutti et al., 2022a). It also outlines daily practices designed to maintain internal balance and prevent disease; treatments include lifestyle adjustments, diet, herbal remedies, and other natural therapies (Johns Hopkins Medicine, 2024; Shivanagutti et al., 2022a).

In sharp contrast, the historical arc of modern Western medicine swung in favor of a reductionist model focused on identifying localized physical conditions and specific pathologies, and treating them with targeted interventions such as surgery and pharmaceuticals. This model spurred advances in germ theory, biomedical research, and technological innovations but at the expense of more comprehensive approaches to diagnosis and treatment. Through prioritizing a clinical and scientific approach, Western medicine also distinguished itself from nature-based and energetic healing practices, and often marginalized or dismissed traditional knowledge that emphasized prevention, holistic well-being, and the mind-body connection.

In the 1970s, and gaining wider recognition in the 1980s, the label alternative was applied to nature-based, holistic, and traditional systems that operate outside the Western medical paradigm (Peters et al., 2002). After some of these alternative practices were scientifically endorsed or integrated into conventional healthcare (Peters et al., 2002) the term complementary was added, although it is now also used to refer to such systems and practices in their own right (Peters et al., 2002). This shift from alternative to complementary reflects increasing acceptance of such therapies within mainstream healthcare and in recent years, there has been growing interest in so-called integrative medicine (see below) which seeks to blend conventional and alternative approaches. However, the degree of scientific endorsement varies with some practices supported by strong evidence, while others remain controversial. Nonetheless, as CAM aligns with the principles of holistic well-being and preventative care, it is considered integral to the wellness paradigm (Perez et al., 2016).

What comprises complementary and alternative medicine (CAM)?

CAM is a collective term for a diverse range of therapies, each based on a unique understanding of the causes, diagnosis and treatment of disease, especially those derived from health systems such as Ayurveda and Traditional Chinese Medicine (see below), which have distinctive historical, cultural and philosophical underpinnings. Examples of CAM therapies include acupuncture, aromatherapy, chiropractic care, herbal medicine, homeopathy, massage therapy, naturopathy, nutritional therapy, reflexology, and reiki (Peters et al., 2002).

The National Institute of Health identified five major categories of complementary therapies as follows:

While CAM therapies and systems of healing vary, many share commonalities. As mentioned, alternative therapies typically embrace a so-called holistic approach that considers an individual’s overall well-being, along with the external factors that impact it (Reiss & Ankeny, 2022). Beginning in the 1970s the term “holistic” became widely applied in the context of health and wellness to capture a whole person perspective, as well as distinguish such an approach from conventional health care which was becoming increasingly high-tech, impersonal, and expensive (Tackett, 1990).  For example, a number of alternative therapies such as homeopathy are characterized by comprehensive examinations and extended consultations. During these consultations, practitioners consider the overall integrity of the physical body which may extend to a patient’s emotional, psychological, and spiritual health, along with the unique circumstances of their external environments (Whorton, 2002).  While the term holistic health is thus often used to describe alternative health care systems, especially comprehensive ones such as Ayurveda or TCM, it can also refer to an approach to health care that combines different healing modalities such as integrative medicine (Patwardhan et al., 2015).
The term holistic from the Greek word holos, meaning “whole,” was coined by South African statesman, Jan Smuts, in his 1926 book Holism and Evolution. His book highlighted the general problem of specialization in science, resulting in discrete fields of study or ‘silos of knowledge’ that ultimately narrow our understanding of complex phenomena as well as the ability to tackle complex problems. 

Another shared principle is a belief in the body’s propensity to heal itself, especially in harmony with nature. Natural remedies using plants, herbs, water,  and even climate and sunlight have been used to support the body’s healing processes (Whorton, 2002).  Affirmation of the wisdom and potency of nature and natural remedies, along with the idea that health is achieved and maintained in harmony with nature, is likewise prevalent within the wellness movement (Baer, Goldstein, 1992).

Finally, alternative practitioners typically value direct insights gained from patient interactions, such as close observation of physical indicators and attention to changes in overall well-being.  Such practitioners have argued that conventional medicine relies too heavily on theoretical deduction and clinical studies, whilst their approach prioritizes the efficacy of a course of treatment as determined through empirical results rather than an understanding of the underlying mechanisms (Whorton, 2002). Conversely, medical practitioners have criticized alternative therapies for their lack of scientific rigor and questionable premises.

Nonetheless, an increasing number of Americans are using CAM, with low estimates around 38% of the adult population (Weerasinghe, 2025). Nearly three-fourths of the U.S. population also feel that conventional healthcare systems are not adequately meeting their needs (Micallef, 2023). Many of them expressed dissatisfaction over the lack of preventative care, and this despite extensive research demonstrating that lifestyle modifications can effectively prevent many chronic ailments such as hypertension, cardiovascular disease, diabetes, and even certain cancers (Micallef, 2023). As the World Health Organization projects that  70% of global deaths will be attributable to chronic diseases by 2030,  (Al-Maskari, 2010), the demand for preventive care and alternative therapies will also likely increase over time.

Highlight: Traditional Chinese Medicine

Traditional or classical Chinese medicine (TCM) is a system of medicine that originated in China over 3000 years ago and is still widely practiced throughout Asia (Lee, 2018; (Xu & Yang, 2009). While TCM evolved and adapted over time, a fundamental tenet posits that the same characteristics and forces shaping the cosmos, for example, the Five Elements (wood, fire, earth, metal, and water) and flow of Qi, also operate within the human body; in other words that the macrocosm is reflected in the microcosm or physical body (Lee, 2018).

Qi is described as vital energy, a fundamental and universal life-force that is expressed in all things via two modes: (1) Qi in concentrating mode (matter) refers to the tangible or material aspects of existence, and (2) Qi in dissipating mode (energy) represents a more intangible force that animates matter (Lee, 2018). The Chinese word for Qi combines the characters of “rice” and “steam,” illustrating this duality. Rice symbolizes Qi’s ability to condense and form matter while steam represents its ethereal, flowing nature (Lee, 2018).

In the human body, Qi is the life force that flows through the body’s intricate meridian system, a network of pathways called Jingluo (Lee, 2018). The Jingluo network also serves as the transportation system for blood, ensuring the proper functioning of the visceral organ-systems (Lee, 2018). Blockages or imbalances in Qi are believed to be the root of illness while maintaining the smooth flow of Qi is essential to good health. Thus, supporting the integrity of these meridians plays a critical role in TCM therapies (Lee, 2018).

Natural phenomena and their relationships are categorized into The Five Elements, a framework that extends to an understanding of the body’s physical functions as well as an individual’s temperament, personality traits, and even destiny in some interpretations, such as in Chinese metaphysics and astrology. The season spring, for example,  corresponds to the wood element, the liver (considered yin) and its catalyst the gallbladder (considered yang), as spring symbolizes growth and renewal, much like the liver’s detoxifying and regenerative role (Lee, 2018). TCM practitioners apply the Five Element framework to interpret symptoms and diagnose imbalances. By identifying which element is out of balance, they may prescribe treatments that restore internal harmony as well as balance between the individual and the external world.

TCM also favors a holistic and preventative approach to health and healing.  Practitioners view the human body as a complex, interconnected system in which the emotional, mental and physical spheres must work in harmony to maintain balance and individual vitality (Lee, 2018). Emotional imbalances such as suppressed anger or excessive emotions can disrupt the flow of Qi and if left unresolved, become significant contributors to physical disease (Lee, 2018). TCM practitioners use a variety of methods to assess the flow of Qi and the integrity of vital organs in the body (Lee, 2018).  They may observe the tongue and complexion, how the body sounds and smells, feel the pulse and ask questions about lifestyle and symptoms, to better understand a patient’s condition (Lee, 2018). They also anticipate potential health challenges and recommend lifestyle and dietary adjustments as early intervention and preventative measures are key (Lee, 2018).

Chinese medicine is time therapy, based in the ancient science of energy dynamics, while Western medicine is space therapy, rooted in the modern science of matter analysis. (Fruehauf, 2006)Popular TCM treatments include acupuncture which stimulates  acupoints on the body to release energy blockages and re-establish the body’s equilibrium and natural remedies such as medicinal plants, minerals and, now more controversially, animal parts to treat patients (Lee, 2018). Other modalities include nutrition and movement exercises like Qi Gong and Tai Chi (Lee, 2018).

Today, TCM remains widely practiced in many parts of Asia, with 90% of general hospitals in China having TCM departments (Xu & Yang, 2009). Among the nearly 4,000 international students enrolled in TCM universities, 90% come from Asian countries, 5% from North America, and 4% from Europe (Xu & Yang, 2009). Many Chinese people also continue to favor traditional practices (Xu & Yang, 2009). While Western medicine is accepted alongside TCM, debates persist on how to effectively integrate these vastly different systems (Xu & Yang, 2009).

From nature based remedies to integrative medicine – a brief historical overview

The use of nature-based remedies has historical roots in ancient civilizations worldwide, with each culture developing unique methods of healing using the natural resources at hand (Ng et al., 2023; Whorton, 2002). The early European settlers brought knowledge of such practices and remedies with them from their respective countries  (Whorton, 2002). Native Americans likewise relied upon indigenous plants for healing, knowledge of which was  incorporated by early colonialists (Craker & Gardiner, 2006). Historically, close plantings of medicinal plant materials were placed near homes for easy use in treating ailments, a practice commonplace in America until the early 20th century. (Silvano, 2021). Up until the late 19th century, medical training for herbalists, midwives, and physicians also included the knowledge and use of plant-based medicines (Craker & Gardiner, 2006).

In a Western context,  formal systems of nature-based cures began to develop around the late 1700s (Whorton, 2002). One nature-based system of healing which originated around that time is Homeopathy, founded by Samuel Hahnemann, a German physician (Ng et al, 2023). Homeopathy is based on the “law of similars,” the principle that a substance that causes symptoms in a healthy person can cure similar symptoms in a sick person, using highly diluted preparations (Ng et al., 2023).  Another such system that became popular in the early 1800s was developed by Samuel Thomson (Whorton, 2002). Called Thomsonianism, this system drew upon folk traditions and extensive experimentation with plants and herbs (e.g. lobelia and cayenne) that Thomson used to create botanical remedies (Whorton, 2002). Vincent Priessnitz’s water cure, which inspired hydropathy, also originated in the early 19th century and was based on his observations of the healing properties of water (Whorton, 2002).

Nature-based remedies enjoyed wide spread popularity during the first half of the 19th century (Whorton, 2002). This was in large part a reaction to  the “heroic therapies” prevalent within conventional medicine at the time (Whorton, 2002). Allopathic therapies of  the early 1800s, for example, included such practices as non-anesthetized surgeries, leeching and blood-letting, and foul-tasting substances that sometimes induced horrific side effects (Whorton, 2002). A particular mercury compound, widely prescribed as a cathartic, even caused painful mouth swelling, bleeding gums, ulceration, loose teeth, and excessive salivation (Whorton, 2002). Such dubious treatments were at best unreliable and quite often harmful, if not life threatening (Whorton, 2002).

Nature-based remedies that supported the body’s natural ability to heal were gentler and more palatable, contributing to the popularity of the doctors who prescribed them. This is evidenced by the fact that approximately 20% of all recorded health practitioners in the 19th century were not conventionally trained physicians (Whorton, 2002). As the century drew to a close, practitioners such as herbalists, massage therapists, hydropaths, and homeopaths enjoyed thriving health practices alongside a growing number of adherents (Tackett, 1990). However, allopathic physicians, for whom such practitioners were professional competition, dismissed them as “quacks” and labeled treatments based on the restorative power of nature as Romanticized ideals (Tackett, 1990). More damaging, however, was the unscrupulous profiteering off the rising popularity of natural remedies, which led to a variety of questionable “cure-alls” being hawked by traveling salesmen (Whorton, 2002). This development ultimately injected a heavy dose of skepticism into public perception, undermining the credibility of natural and nature-based remedies (Tackett, 1990).

The increasing dominance of conventional medicine over the following century was driven by the publication of the so-called Flexner Report (see below), along with scientific medical discoveries, advances in pharmacology, and a good deal of political lobbying (Tackett, 1990). By the end of the 20th century, synthetic drugs had also all but replaced natural and plant-based remedies within conventional medicine. In 1916, 40% of medicinal preparations came from plant extracts; by 1950, this dropped to 9%, and by 1990, only 1% of preparations were derived from plants (Craker & Lange, 2006).

ASPIRIN

Aspirin, also known by acetylsalicylic acid the active ingredient, is one of the most ubiquitous drugs in the world and its use dates back thousands of years. Aspirin originally comes from the bark of the willow tree which contains salicylic acid, the compound responsible for pain relief. The Sumerians and Egyptians used willow bark as a painkiller and fever reducer (Montinari, 2019). Likewise, Native Americans chewed willow bark to relieve aches and pain. British Reverend Edward Stone brought willow bark’s therapeutic effects to a wider audience in 1763, but it wasn’t until 1897 that chemists began artificially synthesizing acetylsalicylic acid; the Bayer company trademarked the name “Aspirin” a year later (Montinari, 2019).

The Flexner Report

Formally known as The Carnegie Foundation Bulletin Number Four, the so-called Flexner Report was published in 1910, having been commissioned by the Carnegie Foundation for the Advancement of Teaching to evaluate and reform medical education in North America (Duffy, 2011). The report led to standardized curricula with a sharp focus on research, significantly professionalizing the field of medicine (Stahnisch & Verhoef, 2012). Educational reforms included raising medical school admission standards and lengthening medical education (Stahnisch & Verhoef, 2012). The proposed integration of medical schools into larger research universities further ensured both clinical research and scientific rigor in education, as well as an academically oriented model of patient care, but at the expense of more holistic and patient-centered approaches (Stahnisch & Verhoef, 2012).

The Flexner Report had a profound and lasting impact on the medical landscape of North America (Duffy, 2011). Abraham Flexner, the report’s author, favored a biomedical model and considered alternative and nature-based cures unscientific, entrenching the divide between conventional and alternative medicine (Stahnisch & Verhoef, 2012). The report also recommended that only physicians trained in approved institutions should be allowed to prescribe treatments, consolidating power within a narrowly defined medical model (Duffy, 2011). These recommendations also led to the closure of many institutions, including CAM-oriented and homeopathic colleges, predominantly African American institutions, and even some psychiatric facilities (Stahnisch & Verhoef, 2012). The publication of the report coincided with an industrializing America and the rise of chemically-based medicine, which further sidelined plant-based remedies (Craker & Lange, 2006). Within a few years, most schools teaching botanical medicine had also closed (Stahnisch & Verhoef, 2012).

While Flexner’s report brought about important reforms in medical education, its assessment of alternative medical practices had a detrimental impact on their use and development. The exclusion of CAM from standardized curricula institutionalized skepticism toward such practices and eroded the perceived legitimacy and overall popularity of non-traditional medical treatments and therapies in both mainstream healthcare and the general populace (Stahnisch & Verhoef, 2012).

Integrative medicine

In the late 1960’s the prevailing medical model remained almost exclusively surgical and pharmacological in focus (Tackett, 1990). During this period, however, wellness advocates began calling for a more comprehensive approach that went beyond eliminating symptoms to health maintenance and disease prevention (Tackett, 1990). The 1960s also saw increasing support for unconventional medical practices and more holistic, human-centered care (Ng et al., 2023).

Ground support grew during 1970s to the point that the medical world was rocked by a “holistic health explosion” (Whorton, 2002).  A unifying contention was that modern medicine was guilty of a “presumptuous expertise” which forced every form of human suffering into its narrow biomechanical construct of disease (Whorton, 2002). The word holistic, having been introduced to medicine in the 1970s, initially referred to the treatment of the whole person (Whorton, 2002). Alternative therapy practitioners embraced the word as an ideal that distinguished them from conventional medicine, expanding its meaning to include the use of natural therapies, preventive measures, and patient education (Whorton, 2002).

Patient demand for complementary and alternative medicine (CAM) also continued to grow throughout the1980s, with more doctors becoming interested by the end of the decade (Whorton, 2002). A 1990 survey found that 34% of adults had used at least one complementary therapy in the past year, a prevalence that had increased to 42.1%, by 1997, although interestingly less than 40% of CAM therapy reported disclosing this to their physicians in both the 1990 and 1997 survey (Institute of Medicine, 2005). By 2002, the number of U.S. adults  who had used some form of CAM in the past 12 months had risen to 62% (Institute of Medicine, 2005).

While skepticism towards CAM in mainstream healthcare persisted, expansion of so-called integrative medicine began to signal a movement towards endorsement of particular therapies. In 1991, the Office of Alternative Medicine (OAM) was founded, becoming the National Center for Complementary and Alternative Medicine (NCCAM) before being renamed, yet again, as the National Center for Complementary and Integrative Health (NCCIH) in 2014 (Ng et al, 2023).  Integrative health, as defined by the NCCIH, brings together conventional and complementary approaches emphasizing multi-modal interventions and holistic treatments involving coordinated care among different providers and institutions (Ng et al., 2023).

By the new millennia, medical and psychiatric education had also begun to change, with trends in certain CAM and evidence-based medicine (EBM) becoming part of the medical school curricula (Stahnisch & Verhoef, 2012). In 2000, integrative medicine took a further step forward with the launch of the American Board of Integrative Holistic Medicine (ABIHM) and  introduction of an inaugural board certification examination (Stahnisch & Verhoef, 2012).  In 2014, the Academy of Integrative Health and Medicine (AIHM) was founded, which coincided with the launch of yet another board certification, this time through the American Board of Physician Specialists (ABPS) (Ng et al., 2023).   While ABPS pointedly refutes the idea that integrative medicine should be considered synonymous with complementary or alternative medicine, they acknowledge that integrative medicine was influenced, in part, by CAM practitioners and may include practices labeled as alternative (Ng et al., 2023).

Dimensions of Well-being

Holistic health is a conceptually complex and multi-faceted term as we witnessed in the wellness models touched upon in Chapter 1.  For the purposes of this course, however, we will focus on three fundamental and individual dimensions that have direct relevance for wellness tourism.  That is, external circumstances of an individual’s daily life and environment (e.g. work, leisure, family etc.) that are not part of the tourism experience, are necessarily excluded. These three dimensions also  comprise the wellness services and amenities that are typically catered to through the wellness tourism industry as we will discuss in Chapter 6: Wellness Tourism Management.

These three are the (1) spiritual, (2) psychological, and (3) physical dimensions of well-being depicted in Figure 5, below. Note that while these dimensions are described separately it is important to keep in mind that they are inextricably linked with each having, “a potentially causal  impact on the other”  (Goldstein, 1992, p. 25).  In practice they are likewise intertwined as exemplified by wellness gurus like Dr. Joe Dispenza  who lectures extensively on personal transformation through meditation and spiritual principles, thus harnessing the power of  thoughts and beliefs to bring about physical and psychological healing.

Figure 5: Dimensions of Well-being

Psychological well-being

The Human Potential Movement (HPM) was the conduit through which psychological theories were circulated within popular culture during the 1960s and 1970s (Longe, 2016). Heavily influenced by Humanistic psychology, HPM centered on a belief in an individual’s untapped potential for growth, creativity, and self-actualization (Dillon, 2020). Although not identical to the New Age movement, the two shared parallel goals including personal evolution, raising human consciousness, and exploring altered states (Dillon, 2020; Reber, 1995). HPM also aligned with the counterculture’s ethos of social change by way of self-exploration and emotional expression (Dillon, 2020). Through encounter groups, which were a core component, HPM thus aligned with the two major social movements prevalent at the time, transforming from a therapeutic approach into a broader social phenomenon (Spence, 2007).

Encounter groups evolved out of sensitivity training, a psychological approach developed in the 1940s to increase awareness of emotions, behaviors, and social interactions (Dillon, 2020). Influenced by Kurt Lewin’s research on group dynamics, which aimed to enhance interpersonal communication and group cohesion (Longe, 2016), sensitivity training was applied in corporate settings in the 1950s to improve teamwork and leadership (Reber, 1995). This approach expanded into the self-help movement of the 1960s, leading to the development of encounter groups (Dillon, 2020; Reber, 1995). Encounter groups built upon the foundation of sensitivity training by emphasizing intense emotional expression, self-exploration, and the confrontation of personal biases (Dillon, 2020). In practice, group leaders created an environment that encouraged participants to share vulnerabilities, address personal issues, and engage in transformative emotional release while receiving group feedback (Dillon, 2020).

By the late 1960s and 1970s, HPM’s popularity had spread ‘like wildfire,’ with encounter groups taking place in a variety of settings such as schools, universities, community centers, and so-called growth centers, making them accessible to a broad range of individuals seeking personal transformation (Dillon, 2020; Reber, 1995; Weigel, 2002, p. 192). As the movement gained momentum, HPM’s emphasis on self-expression and openness fostered an increasingly decentralized environment and one that came to include a variety of additional therapeutic techniques. For example, Gestalt psychology, with its focus on living in the ‘here and now,’ gained prominence, as did Transpersonal psychology, with the exploration of ESP and altered states of awareness taking place at institutions dedicated to human potential, such as the Esalen Institute (see below) (Lewis & Melton, 1992; Longe, 2016).

The allure of HPM soon began to transcend professional boundaries, attracting group leaders from diverse fields such as teaching, theology, art, sociology, and social work, along with avant-garde practices like psychodrama, art therapy, dance, bodywork modalities, and biofeedback (Longe, 2016; Reber, 1995; Spence, 2007). Certain HPM groups incorporated New Age spiritual practices such as Zen Buddhism, yoga, and astrology, while others included participants who supported alternative practices like vegetarianism and natural birthing (Stahnisch & Verhoef, 2012).

The decline of HPM by the 1980s has been attributed to several factors, including its disconnect from rigorous research and descent into sensationalism and commercialism (Seaman, 2016). Critics argued that HPM exploited individuals’ vulnerabilities by offering simplistic solutions rather than genuine transformation (Seaman, 2016). A lack of regulation had also led to varying levels of expertise among group leaders, raising concerns about quality and safety, while the commercial success of associated books and workshops, often based on anecdotal evidence, was critiqued as evidence of the movement’s profit motive over authentic psychological benefits (Seaman, 2016).

Despite its decline, HPM has had a lasting impact on American culture, particularly its influence on emotional disclosure, feedback, and interpersonal communication (Dillon, 2020). HPM’s focus on self-exploration also continues to shape the self-help and personal development industry (Dillon, 2020; Longe, 2016). The movement’s influence can be seen in modern therapeutic practices, such as mindfulness-based therapies, which integrate principles of emotional awareness and self-exploration, while its legacy endures in the continued popularity of retreats, workshops, and transformational seminars that promote self-improvement and holistic well-being (Longe, 2016). HPM’s impact on education can also be seen in the development of alternative graduate programs, the incorporation of sensory awareness and emotional intelligence in schools, and experiential education models like Outward Bound, which emphasizes personal growth, teamwork, and emotional resilience (Dillon, 2020).

PHYSICAL WELL-BEING

In this section we will focus on the two aspects of physical well-being that are addressed not only pillars of wellness but front and center at wellness resorts namely, fitness and diet. In particular, we will be considering how views on these topics have evolved within a socio-historical context, along with notable trends . As you will no doubt note, while an emphasis on physical fitness has been widely integrated as a facet of contemporary life, diet represents an area in which the wellness movement may bee seen as representing a counter point to predominantly negative trends within contemporary society.

Fitness

Prior to the late 19th century, the concept of structured recreational exercise was virtually nonexistent, as the strenuous nature of work in both rural and urban settings naturally integrated physical activity into daily life. Agricultural and industrial labor not only required significant physical exertion, but workdays often extended from sunrise to sunset, leaving minimal time for recreational activities. The Industrial Revolution brought significant changes, shifting labor from rural, agricultural work to urban, factory-based jobs. This transition resulted in lower levels of physical activity among the urban population, as well as introduced the concept of leisure time as a novel facet of daily life.

At the start of the 19th century, health in public discourse largely focused on questions of morality, as good health was equated with moral virtue. “Hygienic religion,” a popular notion of the early 1800s, highlighted the connection between physical well-being and lifestyle choices (Whorton, 2008). Measures such as a restricted diet, adequate fresh air and sleep, and forsaking the “passions of the mind” were ardently promoted over lesser concerns like physical exercise (Whorton, 2014). During the latter part of the 1800s, writers such as Thomas Hughes and Charles Kingsley popularized the idea of ‘Muscular Christianity’—the belief that physical prowess and its pursuits were pathways to moral fortitude in service to God and nation (Whorton, 2014). This concept, set against the backdrop of increasing urbanization and concerns over the moral hazards of city life, propelled exercise into the forefront of hygienic discourse for the first time and led to a surge in weightlifting and gym attendance among men (Goldstein, 1992).

Women in the early 1800s faced another, more pressing concern—both literal and figurative. Health problems associated with the tight-fitting corsets of the time included deformed rib cages, restricted breathing, and damage to the digestive and reproductive organs (Whorton, 2014). Social reformers like Mary Gove Nichols, who lectured on female physiology, challenged conventional norms, rightly arguing that such undergarments not only undermined women’s overall vitality but also hindered their capacity to engage in physical exercise (Whorton, 2014). Although the primary focus of the anti-corset movement was on health and reproductive well-being, it indirectly contributed to the growing awareness of the importance of physical exercise for women. While the majority of ‘respectable’ women would continue to wear corsets for another half-century, Nichols’ ‘oratorical barrage’ and willingness to discuss ‘physiological facts, of a delicate nature’ addressed a gap in women’s knowledge and inspired many like-minded crusaders. The corsetless Bloomer costume, first introduced in the early 1850s, thus became a symbol of the physical liberation of women, leading to increased participation in physical activities from the late 19th century onward.

Around the early 1900s, physical exercise also moved from a secondary consideration to a primary one in institutional settings. Physician-authored handbooks on exercise and physical education, with recommendations for both adults and children to engage in such activities as walking, riding, rowing, swimming, and fencing, became more common. The establishment and growth of physical education programs in schools and colleges further reflected the elevated status of exercise, both within education and for overall development.

Fitness trends had also begun to emerge. Between the Civil War era and the 1930s, Indian clubs became a staple in American physical education. Adapted from traditional Indian war clubs and first introduced to Europe by British soldiers, participants incorporated hand-held clubs into gymnastics routines and public demonstrations, performing flowing movements intended to enhance grace, flexibility, and strength.

A German health and fitness initiative dubbed Physical Culture, which promoted physical prowess as an expression of national strength and unity, spread to America via England and would remained influential until at least the 1920s (Whorton, 2014). One of its most prominent champions was the eccentric Bernarr Macfadden, who established several ‘healthatoriums,’ a magazine to promote the movement, and a community he called Physical Culture City. Macfadden’s views, however, such as the promotion of exercise for women and the belief that sex was vital to human well-being—were considered scandalous at the time. As a result, his endeavors ultimately garnered widespread public criticism and legal troubles.

Following World War I, an increase in wealth and leisure time allowed Americans to embrace recreational activities and participatory sports, and these would become staples of everyday life by the 1920s (Whorton, 2014). During the 1930s and 1940s, physical fitness for national strength and military readiness remained a national focus. Spurred by the Great Depression and World War II, the rise of so-called ‘He-Man’ catalogues—mail-order courses offering bodybuilding and strength development instructions—became popular among men in pursuit of muscular physiques or the ‘He-Man in the Mirror’ (Figarelli, 2008).

The post-war prosperity of the 1950s saw an expanding middle class—and expanding waistlines. A portly physique was even considered something of a status symbol among middle- and upper-class men (Figarelli, 2008). Women, however, faced social pressure to conform to the “hourglass” figure popularized by Hollywood actresses (Figarelli, 2008). At the time, exclusive men’s health clubs—offering services like massage, steam baths, and light exercise through passive machines—dotted urban landscapes. Meanwhile, televisions, which had become a central feature of American households, provided daily exercise programming targeting suburban housewives. The most famous of these was The Jack LaLanne Show, which aired from 1951 to 1985. LaLanne, a San Francisco-born exercise and nutrition guru dubbed the ‘Godfather of Fitness,’ frequently featured his wife, Elaine, who demonstrated his exercises.

Public concern over sedentary suburban lifestyles peaked in the mid-1950s when an international study revealed that American children lagged significantly behind their European counterparts in physical fitness. In response, President Dwight D. Eisenhower issued an Executive Order  establishing the President’s Council on Youth Fitness in 1956. American adults, however, weren’t fairing much better. A national poll conducted in 1960, found that only 24% of Americans engaged in regular exercise (Stern, 2008).

Such trends set the stage for the transformation of fitness culture in the latter half of the 20th century, however, which included evolving attitudes, increased participation, shifting motivations, and the rise of commercial fitness centers across America. One notable figure in this regard was University of Oregon track coach Bill Bowerman. Inspired by jogging practices he witnessed in New Zealand, Bowerman established a joggers’ club in Eugene, Oregon in 1963. He also promoted the activity to a wider audience through a best-selling book entitled simply, Jogging, that was published in 1966. For women, Kathrine Switzer’s historic participation in the all-male Boston Marathon in 1967, despite concerted efforts by race officials to stop her, not only broke gender barriers but played a significant role in popularizing running for women.

Bowerman’s work would also prove impactful in that it influenced public opinion regarding rigorous forms of exercise at a time when bowling was considered strenuous (Stern, 2008). Bowerman collaborated with cardiologists to conduct controlled studies, later published in reputable medical journals, which validated the health benefits of jogging. Two years later, Dr. Kenneth H. Cooper, an American physician and exercise physiologist, published his groundbreaking best-seller, Aerobics, which likewise had a significant impact on public perceptions and by extension, the fitness industry. In his book, Cooper underscored the health benefits of sustained cardiovascular exercise and provided guidelines for incorporating activities such as running, swimming, and cycling into every day routines.

The 1970s marked a turning point as medical opinion shifted firmly in support of regular exercise and public engagement in it transitioned from a niche activity to a mainstream one (Stern, 2008). This decade saw a sustained rise in jogging as well as racquet sports like tennis and racquetball (Figarelli, 2008; Goldstein, 1992). The rising fame of bodybuilders like Arnold Schwarzenegger raised the stakes for men (Juneau, 2024), while the introduction of Title IX in 1972 significantly boosted women’s participation in sports and fitness activities. Pioneered by Jacki Sorensen in 1969, aerobic dancing spread like wildfire under the enthusiastic influence of a growing network of aerobic instructors. The fitness movement even began gaining traction in corporate settings as companies recognized the benefits of exercise for employee productivity and morale (Stern, 2008).

The 1980s solidified the transformation of exercise into a dynamic phenomenon that intertwined the pursuit of health with beauty standards and social status (Goldstein, 1992). During an unprecedented “Fitness Boom,” participation in regular exercise reached 69% by 1987, while home-exercise equipment sales surpassed $1 billion for the first time (Stern, 2008). Health clubs evolved into social hubs, offering trendy aerobics and jazzercise classes. Buzzwords like “power walking” and “aerobics” became commonplace, and workout attire became a fashion statement in popular culture (Figarelli, 2008). The media also played a significant role, with mainstream magazines, news outlets, and television showcasing exercise programs and toned physiques. Meanwhile, celebrities like Jane Fonda fueled the home workout video explosion, and Olivia Newton-John’s song Let’s Get Physical topped the charts in 1981 (Figarelli, 2008).

The fitness boom of the early 1980s leveled off toward the end of the decade, with the number of fitness clubs declining from roughly 14,000 to 9,000 between 1987 and 1990 (Stern, 2008). The more subdued, less body-conscious zeitgeist of the 1990s also shifted the emphasis from flamboyant exercise gear and workouts to a personalized approach, with individuals seeking customized workout plans and guidance. Popularized in the early 1990s, spinning classes, for example, offered structured, instructor-led workouts that could be tailored to individual fitness levels. This decade also saw the proliferation of personal trainers, as fitness training became recognized as a field of specialized knowledge with professional certifications (Figarelli, 2008).

By 2000, fitness centers were, once again, ubiquitous across the American landscape (Stern, 2008). The early 2000s saw new and diverse group exercises gain popularity, with Zumba replacing aerobics and Tae-Bo at the height of its influence (Figarelli, 2008). Founded in 2000, CrossFit, which combined various training disciplines into a high-intensity regimen became hugely popular while Outdoor Boot Camps and Obstacle Course Races also grew, reflecting a shift toward adventurous fitness (Figarelli, 2008). The rise of fitness tech was also notable during this decade with the launch of the Fitbit Tracker® in 2007. Finally, during the 2010s, while a wide variety of exercise programs continued to be popular, it was fitness communities that flourished, providing social connections and support systems for individuals seeking lifestyle changes, overall wellness, and belonging. This period also saw a growing emphasis on inclusivity and body positivity, making fitness culture more accessible to diverse populations.

Diet

An obvious and inextricable link between good health and good food has been recognized since ancient times, while attention to diet for health maintenance has proved a perennial point of interest among physicians, spiritual leaders, and scholars across civilizations. Likewise, in the United States since at least the late 19th century, the question of what constitutes a healthful diet has rarely gone unanswered. Nutritional recommendations have been dispensed through popular books, the media, community leaders, and cultural icons, backed by the moral authority of the medical profession, the Church, scientists, and government-issued guidelines (Du Puis, 2007).

Let food by thy medicine, and medicine be thy food. – Anonymous

Over the ensuing decades, the volume of information on healthful diets only increased, even while the average American diet steadily declined. Since the mid-20th century, there was a notable rise in the consumption of processed foods, with a concomitant decline in minimally processed foods, despite both information about the importance of eating wholesome products and health food products themselves becoming more readily available over time (Juul et al. 2022).

In the 1980s, the term ultra-processed food was introduced to describe products largely devoid of whole ingredients and which had been industrially manufactured with multiple additives as ready-to-eat or ready-to-heat formulations. Consumption of ultra-processed foods has also increased across all income and education levels, lending support to one social commentator’s claim that “middle-class Americans love to read advice about how to eat while mostly ignoring it” (Du Puis, 2007, p. 34; Juul et al., 2022). Nonetheless, beginning with the countercuisine movement of the 1960s, the popularity of health foods and the number of organically certified farms have also steadily risen over time. Thus, while the counterculture did not fully transform the American food system, it introduced alternative views and practices that continue to resonate within the modern wellness movement. The concurrent emphasis on a return to nature and natural food products are likewise evident in wellness perspectives on local and organic foods, today. Both of these trends will be touched upon, in brief, below.

In the 1800s, the American diet centered around animal meat as the main dish, accompanied by a variety of other foods such as fruits, vegetables, grains, dairy, legumes, sweetmeats, sugar, and alcohol—a pattern established during the colonial period (Adams, 2014; Belasco, 2007). By the late 19th century, this dietary pattern faced criticism from health reformers due to its high consumption of meats, rich foods, and caffeinated and alcoholic drinks, leading to a growing movement advocating for simpler, lighter, and more “natural” foods (Adams, 2014). At that time, and while meat remained a central component, Americans still obtained a larger percentage of their calories from fruits, vegetables, and grains than they would in the latter part of the 20th century (Belasco, 2007). As well-known author and nutritionist Jane Brody noted, a general trend in the average American diet over the course of the 20th century has been, “away from plant-based foods such as grains, beans and peas, nuts, potatoes, and other vegetables and fruits, and toward foods derived from animals meat, fish, poultry, eggs, and dairy products” (Brody, 1985, p. 2).

An even more notable shift from whole to processed foods over the course of the 20th century accelerated the declining quality of American diets, with factors such as technological innovations, the changing roles of women, and the food industry’s focus on profit over health proving decisive. In the early 1900s, home-cooked meals were prepared from scratch, including staples like home-baked goods, canned and preserved fruits and vegetables, and a variety of dried meats, herbs, and grains (Bowers, 2000). During this period, women spent, on average,  44 hours per week on food preparation (Bowers, 2000). Over the coming decades, the growing availability of kitchen appliances such as electric and gas ranges, refrigerators, and microwaves helped streamline domestic labor, reducing both time and effort (Bowers, 2000).

Following World War II, further technological advances led to a proliferation of commercially per-packaged foods such as dry cereals, canned goods, frozen dinners, and packaged mixes, which offered quicker alternatives to traditional meal preparations (Bowers, 2000). The frozen “TV dinner,” introduced by Swanson in 1953, became emblematic of 1950s food culture, symbolizing the era’s embrace of convenience.

In the 1970s, when an unprecedented number of women entered the workforce, convenience became paramount as women juggled professional and familial obligations, and time constraints began to significantly impact eating habits. In the 1950s, the average amount of time a woman spent on meal preparation had dropped below 20 hours per week; by 1975, it was just 10 hours (Bowers, 2000), and by the close of the 20th century only 55% of American dinners included a homemade dish (Bowers, 2000).

Several factors such as the low cost and proliferation of processed foods, as well as the aggressive marketing tactics of the food industry also shaped American eating habits (Juul et al., 2022). Advancements in food processing technologies using methods like canning, freezing, and dehydration—along with additives and preservatives (e.g., sodium benzoate, BHA, BHT), artificial sweeteners (e.g., saccharin, cyclamate), flavor enhancers (e.g., MSG), and colorants (e.g., FD&C dyes) allowed for the mass production and preservation of foods (Buchholz, 2023). These additives were used to extend shelf life, improve taste, and enhance visual appeal, often with little regard for health impacts (Buchholz, 2023).

Public concern over the safety of chemicals in food, and the subsequent government response, ultimately led to the establishment of regulatory agencies such as the Food and Drug Administration (FDA) to more rigorously oversee food additives (Moss, 2013). In response, food companies implemented aggressive marketing tactics while also lobbying government. One prominent example was a well-known nutritionist who, after being hired by General Mills in the late 1950s, publicly defended white bread and other processed foods, despite having warned of their lack of essential nutrients and potential health risks a few years prior (Goldstein, 1992). Government scrutiny peaked in the 1970s when, in 1976, the Select Committee on Nutrition and Human Needs described the typical American diet as “super-rich, fat-loaded, additive, and sugar-filled” (Moss, 2013). In response, the food industry became increasingly aggressive, actively lobbying the government on a variety of fronts (Belasco, 2007). The industry’s efforts included fighting proposed regulations related to food safety and labeling, fighting the regulation of children’s television advertising, and attempting to roll back dietary recommendations that threatened their products’ sales performance (Belasco, 2007).

Another consistent tactic used by the food industry in response to public health concerns involved reducing one unhealthy ingredient (e.g., salt, sugar, or fat), while increasing the relative proportion of another to maintain taste, appeal, and profitability (Rasmussen, 2019). The rise of “light” and “low-fat” products that began in the 1960s, driven by consumer demand for healthier options, is one such example (Rasmussen, 2019). At that time, all fats were regarded as detrimental, overshadowing the health benefits of fats from sources such as avocados and fatty fish like salmon (Healthy Eating, 2020). This pattern continued into the 1980s and 1990s, when low-fat diets dominated the nutritional landscape, prompting the widespread marketing of products that were low in fat but high in added sugars to enhance flavor (Healthy Eating, 2020). It wasn’t until the early 2000s that low-carb diets, popularized by books like Dr. Atkins’ Diet Revolution and The South Beach Diet, began to replace low-fat trends, despite ongoing controversy surrounding their long-term efficacy and health impacts (Mahdi, 2006; Landry et al., 2021).

Shifts in eating habits also included not just what people ate, but how much as well as where they consumed their food. Beginning in the 1970s, average food consumption rose across all major food groups, driven by rising income levels and a growing appetite for convenience (Wells & Buzby, 2008). Food dollars spent on meals consumed outside the home increased significantly from 27% in 1960 to 47% in 1998, while fast food sales began to surpass those of restaurants and lunchrooms by the 1980s (National Research Council, 1986; Bowers, 2007).  Taken together, the growing reliance on processed foods, restaurants’ larger portion sizes, and the expansion of fast-food chains nation-wide contributed to a sharp rise in obesity, and by 2003 Americans held the dubious distinction of being the most overweight population in the world (Critser, 2004; Juul et al., 2022).

At the same time, most Americans were falling short of federal dietary recommendations for essential food groups such as fruits, vegetables, whole grains, and low-fat dairy (Wells & Buzby, 2008). But, given their low cost and high availability, the consumption of ultra-processed foods only continued to rise, increasing from 53.5% to 57.0% of daily energy intake among U.S. adults between 2001 and 2018 (Juul et al., 2022). While one study actually reported a decline in the number of U.S. adults consuming poor diets, from 49% to just over 37% between 1999 and 2020, even the more conservative estimate suggests that over one-third of adults regularly consumed foods detrimental to their health (LaMotte, 2024).

The consequences of such eating patterns were already apparent, with an estimated 40% of all cancer deaths being attributed to poor diet as early as 1978 (Goldstein, 1992). Today, the long-term impacts of poor nutrition continues to shape public health. In addition to contributing to the leading causes of death in America, namely cancer and cardiovascular disease, poor diets have been linked to a range of chronic health conditions, such as high cholesterol, high blood pressure, high blood sugar, and diabetes (Nunes, 2020).

The health food movement

As early as the 1950s, public health officials began expressing concerns about the typical American diet, noting that a quarter of the population was overweight or obese (Rasmussen, 2019). This decade’s health food movement was “typified by dieting,” as thinness came to symbolize self-control and a higher level of health (Goldstein, 1992, p. 50). Diet foods and weight-loss programs emerged, promoting an “ideal” weight as defined by actuarial tables, the perusing of which had become a national pastime (Rasmussen, 2019). Weight gain was also increasingly framed as a psychological issue, often attributed to emotional issues or a lack of willpower (Goldstein, 1992). Popular diet groups that emerged in 1960s, such as Weight Watchers and Overeaters Anonymous, perpetuated perceptions that weight-loss was essentially a matter of self-control, or more pointedly, a lack thereof (Goldstein, 1992).

In the 1960s, however, the socially radical counterculture movement would initiate a far more fundamental and far-reaching challenge to both the dominant food-production systems and established food industry. The term countercuisine was coined to refer to a range of alternative practices and beliefs that centered on three major elements: (1) radical consumerism, (2) therapeutic exploration of food, and (3) the organic paradigm.

Proponents of radical consumerism were driven by a profound distrust of the industrialized food system, which they saw as producing unhealthy, artificial, and environmentally destructive food (Belasco, 2007). Critics of the food industry further condemned the prioritization of profits over health and viewed the industry’s marketing tactics as manipulative (Belasco, 2007). A central tenet of the countercuisine movement was the belief that natural food equated with health, while “plastic” food was harmful. The movement thus rejected foods containing additives and preservatives in favor of natural ingredients and traditional preparation methods (Belasco, 2007). For example, beneficial microbes found in fermented products such as yogurt and pickled foods were championed over sterilized or chemically preserved alternatives (Belasco, 2007). Similarly, diets “lower down the food chain,” or closer to their source, such as whole grains, brown rice, fruits, and vegetables, were recognized as being less contaminated by industrial processing, as well as richer in nutrients, fiber, and essential vitamins and minerals (Belasco, 2007). Finally, the movement recognized the ecological benefits of plant-based proteins such as soybeans, and many embraced vegetarianism out of ethical concerns for animal welfare (Belasco, 2007).

The therapeutic exploration of food emphasized the joy of cooking, experimentation, and connection to food origins (Belasco, 2007). The movement encouraged adherents to prepare meals from scratch, employ improvisation and craftsmanship, and explore different ethnic and regional cuisines, particularly those perceived as less processed and more authentic (Belasco, 2007). In the 1970s, the burgeoning interest in “gourmet” cooking and international culinary traditions perpetuated the perception that these were healthier alternatives to the conventional American diet (Bowers, 2000). Some countercuisine adherents also adopted Eastern dietary ideas, such as macrobiotics, which advocated for a primarily vegetarian diet centered on brown rice and soy sauce (Belasco, 2007).

The countercuisine movement’s rejection of artificial processes and additives, along with its preference for fresh, seasonal foods, extended beyond food manufacturing to a critique of farming practices reliant on chemical inputs and mechanization. This ethos crystallized in the organic paradigm, which advocated a return to pre-industrial or traditional farming methods (Belasco, 2007). Following World War II, the rapid adoption of agricultural and food production technologies significantly increased productivity and food security. However, these advancements also had negative impacts on environmental and human health.

Dubbed the “Green Revolution,” the introduction of high yielding crop varieties and modern farming techniques transformed agricultural practices. The widespread planting of monocultures, use of synthetic fertilizers and pesticides, and the mechanization of farming through tractors, combine harvesters, and other equipment streamlined operations, improving efficiency and boosting productivity. However, these changes also degraded soil health, contributed to water contamination, reduced biodiversity, and through industrial processing and distribution systems, diminished the nutritional quality of crops. Additionally, farm consolidations, in which smaller family farms gave way to larger, more specialized operations, were driven by economies of scale, technological progress, and changes in agricultural policies that prioritized efficiency and profit over environmental sustainability and the well-being of rural communities. As these consequences became more apparent, such methods were increasingly viewed as unsustainable, prompting the rise of movements advocating alternatives to industrial farming.

As the organic paradigm evolved, it came to reflect a deep-seated concern over the entire supply chain, along with support for localized food production and sustainable food distribution networks (Belasco, 2007). The overarching aim was to connect counterculture consumers more directly to the origins and production of their food, while also offering choices that aligned with their personal values through a radically decentralized food infrastructure of communal farms, cooperative grocery stores, and restaurants offering organic foods and promoting sustainable principles. Food cooperatives, for example, provided an alternative to corporate-controlled supermarkets by offering fresher, healthier and locally sourced produce, empowering consumers with greater control over their food choices, and fostering a sense of community and shared responsibility.

The countercuisine movement, however, faced numerous challenges in translating its visions into reality. Internal tensions arose between different dietary camps, such as between vegetarians and those who consumed a meat-based diet. The movement’s reliance on a “craft” approach to food preparation often clashed with the convenience demanded by modern lifestyles while the organic paradigm faltered because it underestimated the resilience of the giant food industry, as well as the industry’s ability to both undermine and co-opt emerging trends. The popular back-to-the-land movement that had also emerged at this time, whereby the younger generation sought to farm and garden organically, would also ultimately prove unsuccessful due to the realities and high demands of farm-life (Belasco, 2007).

In response to the countercuisine movement, the food industry characterized radical consumerism as extreme, faddish, and misinformed. They argued that the movement’s rejection of processed foods was based on unfounded fears while an emphasis on natural foods was overblown as even processed foods and additives were ultimately derived from natural sources. The food industry also defended processed foods based on convenience, arguing that it raised standards of living and helped consumers meet their basic nutritional needs. Food companies further capitalized on vague, unvetted terms such as “healthy foods” to market a variety of low cholesterol and low sodium options, as well as dietetics such as reduced fat or low calorie, without effectively addressing the nutritional value of their products (Belasco, 2007).

Likewise, the initial lack of regulation meant that “organic” products could be marketed without adhering to any sustainable agricultural principles or standards, which not only eroded consumer confidence but also hindered the development of supply chains dedicated to organic producers, distributors, and retailers (Belasco, 2007). The absence of standardized practices made organic farming especially vulnerable to criticism. Opponents launched coordinated efforts to discredit organic agriculture, portraying it as inefficient, unscientific, and potentially hazardous to health due to concerns about lower yields, the use of alternative pest control methods, and the absence of synthetic chemicals that they claimed ensured food safety and quality. While media outlets initially portrayed the countercuisine movement and its aims in a positive light, negative coverage soon followed. Journalists, often relying on “expert” opinions from food industry–affiliated scientists and nutritionists, depicted countercuisine advocates as eccentric, irrational, and even dangerous, frequently using labels such as “nuts,” “flakes,” and “cultists” to describe the movement’s followers.

Despite these challenges, the 1970s witnessed heightened awareness of the connection between diet and health, influenced by the ongoing counter-cultural and environmental movements as well as emerging scientific research linking poor diets to disease. The rise in the availability of health foods also reflected a growing demand for healthier options (Nunes, 2020). Market research from the 1970s and 1980s, however, suggests that this initial wave of health food enthusiasm was largely confined to a more affluent segment of society; evidently, cost, accessibility, and ingrained dietary habits posed barriers to wider adoption of healthier diets (Belasco, 2007).

Nonetheless, many of the values and practices championed by the countercuisine movement such as the emphasis on whole foods, natural ingredients, and sustainable farming practices, would gradually became integrated into mainstream culture. In addition to the proliferation of health foods in conventional supermarkets, the popularity of farmers markets and local food initiatives reflected a growing trend toward consumers seeking out staples produced closer to home (Martinez, 2013). Also notable was the institutionalization and growth of the organic farming. In 1990, the U.S. Congress passed the Organic Foods Production Act (OFPA), which went into effect in 2002 and by 2022 there were approximately 17,445 organically certified farms in operation (Clarke, 2021).

More recent trends continue to reflect increasing consumer recognition of the link between diet and overall well-being (Chartrand et al., 2024; Martinez, 2013; Pirog, 2014). The term superfoods (see below) first emerged in the 1990s (Rani et al., 2024), and it, along with other so-called functional foods, such as those providing instant nutrition, used as everyday performance foods, or undergoing health-enhancing food processing, have become prevalent in recent years (Dwivedi & Keshari 2022; Sloan, 2014). Driven by consumer demand for healthier lifestyles, the number of new conventional food products introduced with health- and nutrition-related claims, such as “whole grain,” “high fiber,” “antioxidants,” and “omega-3,” also increased significantly from 2001 to 2010 (Martinez, 2013). This shift in consumer preference is further reflected in the growing popularity of organic food products. In 2022,  nearly a third (30%) of U.S. consumers reported opting for organic food options over conventional ones, often citing a preference for foods free from chemical fertilizers, preservatives, hormones, additives, and genetically modified organisms (Statista, 2024).

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